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BMA chairman warns reforms add to threat of 'two-tier NHS'

Published on 26/04/04 at 05:29pm

The chairman of the BMA has warned that new reforms are adding to the threat of a two-tier NHS posed by the creation of foundation trusts.

Chairman James Johnson said the plans to allow doctors to qualify as consultants without undergoing current levels of specialist training, were the greatest threat to a two-tier NHS.

"A doctor with only five or six years of postgraduate training would not have the same expertise that patients expect and deserve from consultants," Mr Johnson told the BMA Junior Members Forum in Edinburgh.

"They would be a completely different animal, without the ability to practice autonomously, or deal with the full range of emergencies in their specialty." Meanwhile, Mr Johnson welcomed the government's drive to increase patient choice and stressed that it had to be made available to all patients in a meaningful and well-informed way.

"If information about healthcare is only available to white, middle class English speakers, we will disadvantage the patients we most need to empower," he said.

He suggested that lay people who know the system could direct these patients towards sources of information.

Reiterating his fears about foundation hospitals, Mr Johnson said increased competition in the NHS and a failure to give all hospitals the same freedoms as the top performing trusts could also contribute to large variations in the quality of patient care.

"Until all hospitals have the same freedom from Whitehall control as foundation trusts, the quality of treatment you get could depend on where you live. Are we moving back to the era of the postcode lottery? Let's hope not," Mr Johnson said.

The first ten NHS Foundation Trusts were established at the beginning of April and were hailed by Health Secretary John Reid as  major step on the road to decentralisation and freeing up the NHS from day-to-day Whitehall control, a freedom the government says will eventually be extended to all Trusts.

On the question of patient choice, the Department of Health (DH) has acknowledged that patients and GPs need clear and accurate information on the different options available.

The NHS is due to make its first electronic bookings this summer, allowing patients to choose, from a menu of options, which hospital they would like to attend at a date and time to suit them, seen by the government as a crucial step in redesigning the NHS around patients' needs and choice.

From December 2005,  patients who need an operation will be given a choice of four to five hospitals, or other appropriate providers, at the point of GP referral for their treatment.

A recent report into pilot schemes by independent healthcare quality authority Dr Foster found patients value the offer of a choice of treatment location, even if they still go to their local hospital and that GP consultation times do not significantly increase as a result of offering patients more choice.

It also found that patients want detailed information about their conditions and more information about healthy lifestyles and preventing illness.

Health Minister John Hutton said: "We are hearing time and time again that information is essential for patients to have real choice. We are already making major investment in IT systems and patient information across the NHS and we will ensure there is no loss of momentum in this programme of reform. 

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